Risk factors for suicide attempts similar for soldiers regardless of prior mental health diagnosis

Regardless of whether or not they have had a prior mental health diagnosis, risk factors were still similar among soldiers who attempted suicide, according to a new JAMA Psychiatry study published Aug. 29. Researchers hope these findings will help continue to better understand risk factors in soldiers who have not been seen for a behavioral health diagnosis, and ultimately lead to identifying possible interventions.

The study, "Suicide Attempts Among U.S. Army Soldiers Without a History of Mental Health Diagnosis," was conducted by the Uniformed Services University of the Health Sciences (USU) in collaboration with Harvard University, University of Michigan, University of California San Diego, and the VA San Diego Healthcare System. The researchers sought to look at whether predictors of suicide attempt were different for soldiers without any evidence of behavioral health problems, as part of a continued effort to identify risk factors for suicide and suicide-related behavior in the military. While the study looked at soldiers in the Army, these findings have implications for other services and the national issue of suicide.

The researchers focused on 9,650 enlisted soldiers (not including Guard or Reserve members) serving from 2004 through 2009, who attempted suicide as documented in military medical records. This amounted to about 3,500 suicide attempts.

Similar to those with a past mental health diagnosis, soldiers who attempted suicide, with no past mental health diagnosis, were more likely to be female, younger, non-Hispanic white, less educated, and in their first four years of service. About 21 percent of those who attempted suicide, with no behavioral health history, were in their first year of service.

Regardless of a past behavioral health history, the study found, being demoted or late for promotion to E2, E3, or E4, or having been in a combat arms or combat medic military occupational specialty, were also risk factors, according to the study.

Importantly, the risk of suicide attempt, in both groups, also increased with a history of family violence, having been the victim of a crime, or having committed a crime. Additionally, with or without a behavioral health history, soldiers were more likely to have had at least one outpatient clinic visit in the two months before their attempted suicide. Those with eight or more visits were three to five times more likely to attempt suicide. Those who attempted suicide were also more likely to have suffered a recent physical injury, and the risk was higher for more serious injuries, such as those requiring hospitalization. Interestingly, combat injury was associated with increased odds of suicide attempt only among those with no history of a behavioral health diagnosis.

"The study is one of few to be able to examine risk of suicide attempt among those without a past mental health diagnosis," said Dr. Robert Ursano, director of USU's Center for the Study of Traumatic Stress. "The similarity in risk predictors suggests that interventions that may be helpful may be similar for both the group at risk with a past history of mental health diagnosis and those without. Important times for identifying risk may be present after recent physical injury, family violence or being a victim or perpetrator of a crime."

Suicide attempts in the Army are also an important medical crisis and are much more frequent than completed suicides, Ursano added. Suicide attempts require help for the individual and potentially help for the Army unit of the soldier in sustaining its mission.

The study was part of the Study to Assess Risk and Resilience in Servicemembers – Longitudinal Study (STARRS-LS), a research project led by Ursano, running from 2015 to 2020. The project is designed to provide actionable information to reduce suicide-related behavior, and other mental/behavioral health issues in the military. It also expands the work of Army STARRS, the largest research study of mental health risk and resilience ever conducted among Army personnel, running from 2009 through 2015.​